Hinesh
@Hinesh_
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𝟗𝟕% 𝑬𝒔𝒑𝒓𝒆𝒔𝒔𝒐 | #SuicidePrevention
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🧵A shortage of pilots
There’s a shortages of pilots, to train a pilot it takes 5+ years. To address the shortages a new role is created, pilot assistant (PA). They go through 2 years of training to equip them to assist pilots. The key here is the training is superficial.
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Thread:
Doctors were told that PAs and MAP would help release them from tasks so they could focus on their training and gain the learning experiences needed to be a consultant
But now doctors have to compete for these learning opportunities with PAs and MAPs
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Earn £50,000 annually working 9-5 in London, while enjoying weekends off
Can deliver ‘continuity of care’ because they don’t have to rotate every 4 or 6 months
Pick any speciality because the funding from the government exists, and very little competition for the role. No need
Can anyone give me one thing a PA can do that a doctor cannot?
Anyone? Please? I've been asking for months, just help me out, I beg.
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I have plans to exit healthcare by FY2
I get told a lot that it’s just as hard in the finance industry
My response is this:
You’re compensated well for your hard work, in medicine you invest 10 years just to be told ‘future earning potential’ be happy with £33-50k
This is my favourite tweet today.
A post CCT fellow being offered a poor salary in a London trauma centre, and the defence is still ‘but what about earning potential’.
🙄 10+ years of life sacrifice, exam, other ridiculous fees.
This is exactly why I left. It won’t stop.
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You seemed to have ignored that a doctor has to
1) sit professional exams at their own cost to progress
2) relocate from city to city at a huge cost to them and their families
3) work anti-social hours, which again can come at a cost e.g. arranging childcare for on-call
@dobbyjog
@Dr_BellaR
Not the answer to my comment. I think it’s really really unfair for one profession to pick on another. I feel It has to stop. It’s demeaning to us all.
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Yes, because I can walk into a hospital and start working as a doctor without paying any GMC fees, indemnity insurance, professional exam fees, the list goes on
We also have expenses
@dsarwar7
Thats not the same thing. Businesses have expenses to pay for. Rent, rates, tax, staff wages, cleaning, marketing etc etc
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Perhaps the
@gmcuk
& possibly
@drcolinm
could help with this?
Are you satisfied with Aston Medical School using a PA to assess final year medical students who would then be awarded a PMQ for provisional registration on the GMC Register?
Are these exams valid, considering PAs
Physician Associates now assessing final year medical students.
Is this a sign of declining educational standards in medicine?
What impact will it have on the quality of doctors we produce?
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FY1 Doctors have to work more than 48hrs a week, does anti-social hours and has more responsibilities than a PA but gets paid less than a PA working a typical 9-5 week
Maybe
@VictoriaAtkins
, ‘Health Secretary in Training’ can answer why she thinks that’s fair
'They are there to work alongside doctors not instead of doctors.'
Health Secretary Victoria Atkins reiterates 'regulations' on physician associates after the death of 30-year-old Emily Chesterton.
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I am struggling with this statement, especially when you state ‘We are extremely supportive of all our junior doctors’
You’re offering an FY1 half of what you’re offering a PA.
How is this supporting your junior doctors?
Statement from the Trust ⬇️
In response to concerns and questions raised on X following the publication of a screenshot from our booking system, circulated on Wednesday, the Trust would like to make clear that the original screenshot shared was incorrect.
The rate card
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A patient sees the Pain Team
A person calls the F1 to prescribe a pain killer, they introduce themselves as a consultant.
A weird request, so a quick check of the patient's notes shows it was signed off by Dr. F & Surname, Consultant Nurse
Patient believes they saw a doctor
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Hello
@NNUH
,
Can you please explain how a PA spending time in theatre frees up time for other activities for doctors?
In other words, doctors are stuck on the ward doing ward duties while the PA is in theatre!
A total shambles!
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6 year of Medical School
£100k in student finance loans
and today my payslip for working in central London is £15.00 an hour
I was paid more as a dispensing assistant
Keep striking until they get the message
#FullPayRestoration
4th year doctor in the NHS. My pay? £19/h.
Last few days, my job includes
- Emergency surgery to removal foreign bodies
- Managing patients with life-threatening conditions
- Assisting major operations including cancer removal
This is NOT okay.
#FullPayRestoration
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I am not surprised that Emma Glen, the author of this reply, is posing to be a medical doctor while claiming not to have any intentions to deceive the public into thinking that PAs are doctors
If you haven’t gone to medical school, do not have a PMQ, you’re not a medical doctor
You CANNOT study Medicine in 2 years.
Physician Associates didn't study Medicine too.
Full stop.
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Debunking reasons given for PA/AA expansion:
PAs provide continuity of care for patients
A: Scrap rotational training for doctors
PAs/AAs help address the workforce shortages
A: Increase the number of speciality training posts for doctors & address the retention issues
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Finally it’s not bullying or toxic for pilots to be concerned about the scope of practice of a PA, and the risk they pose to passengers when PAs begin to act beyond what they were designed to do.
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The training isn’t thorough but enough to assist pilots. The PA role was never designed to replace pilots.
It turns out a few years later that PAs starting salary is more than a 1st year pilot. The 1st year pilot has more responsibilities and takes on more risks.
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Remember that
PAs were never designed to replace, always there to assist. They never went to ‘pilot school’ or completed ‘pilot training’ they should not use the title ‘pilot’ to refer to themselves as so many of them have been found to do.
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Doctors are raising concerns about a department, & your response was to refer them to the GMC social media guidance.
It could be argued that this is a tactic to bully and intimidate colleagues to stop raising concerns
Maybe an independent investigation is required of your 1/2
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Pilots begin to raise awareness through social media and news outlets only for pilot assistants to brand this as bullying and toxic.
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With greater awareness it also transpires that PAs have been flying planes that only a pilot of 4 years + experience should be flying.
Hundreds of pilots begin to become concerned that pilot assistants are putting passengers’ safety at risk.
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and again
#BeKind
is used to brush off concerns raised
Yes I agree not all the relevant clinical information is available, but what isn’t open to debate is that
PAs do not work exactly like a doctor does just with a different training programme.
Sending support to the poor woman in this video who is getting absolutely BATTERED by medics who, in their infinite perfection, think they can interpret her occupational ability and general worth off of a 2 minute edited examination made for TV.
People forget
#BeKind
real quick.
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Privilege?
First generation in my family to go to medical school, university, & college
Attended a college ranked in the bottom 25% in the UK
I certainly was not privileged, nor does expecting to be paid properly for the skills/knowledge
@DrDavidRouse
@TheBMA
This stinks of privilege. Oh no poorer people are getting closer and closer to my salary.
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PAs shouldn’t be used to cover doctor rota gaps.
FY1 doctors are not allowed to locum outside of their rotations
A fifth year medical student can’t take up a FY1 rota gap
Rota gaps are fixable, unfortunately using a PA isn’t one fix
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This is the very definition of pulling the ladder up on your trainees
There are multiple reasons why PAs can’t do advance procedures, the moment you say this you make doctors’ hardship of going through medical school, FY1&2, and sitting of professional exams meaningless
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@drcolinm
@donalmurray2002
@gmcuk
So a genuine question why is the GMC stating that it will not give unique registration numbers to PAs/AAs which would be different to doctors on the grounds of costs?
HMG is paying for the creation of said register, and MAPs would fund said register through retention fees
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This is all against the backdrop of doctors seeing a drop in their real term salary
We need to protect our profession and fight for a better tomorrow
This isn’t a bashing of other professions, but raising the need to DEFINE these roles so that doctors can be doctors!
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The UKFPO needs to be reformed or abolished, every year, the organisation responsible for the 'effective delivery of postgraduate training' makes substantial mistakes which has a negative impact on medical students across the UK.
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@jadewelshy
What I found shocking in family court is how easy perpetrators lie both in their witness statements and oral statements and this goes unpunished. Perjury just doesn’t exist in family courts.
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Why this tweet is dangerous and weakens any confidence in the GMC
The GMC was set up to differentiate doctors from non-doctors.
The Medical Act makes reference to Medical Practitioners, and this was synonymous with doctors. To suggest anything else is an insult to us all. 1/2
Interesting debate on titles-
The Medical Act (1983) almost always refers to ‘medical practitioners’ not doctors (or medical professionals).
#GoodMedicalPractice2024
means AAs and PAs once in UK regulation will have to follow the same high professional standards as doctors.
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Do see the problem with refusing to establish a separate register for PAs/AAs?
Sharing the same registration format as doctors creates ambiguity. As a regulator with a focus on patient safety & maintaining public confidence in the profession, this decision is far from wise. 1/2
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We have FY1s being handed jobs lists while a PA goes off to clinic
When I was an F1 in certain surgical job, "senior" PAs with 2+ years experience would be considered "registrar level", have clinics, go to theatre. Worst is after a ward round, F1 colleagues & I often get messages ordering us to prescribe things, order scans, do the jobs etc.
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Failure to define the scope of a PA has meant they’ve gained equivalence to a consultant. Elsewhere they’ve gained equivalence to either a registrar or SHO.
You might say now they will be regulated soon, so scope will be defined quicker but the GMC has deflected this
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Not only are there rogue MAPs and PAs claiming to be superior to doctors but they actively undermine our profession
@asktheorthoPA
Please don’t go anon and then give us the
#bekind
lecture Nasha, your views are out there for all to see.
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The
@RCPhysicians
actively undermining the profession by stating PAs are able to function ‘autonomously’
How can anyone be a “middle grade” in acute medicine if you can’t prescribe basic medications or request ionising imaging?
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The government created a shortage of doctors by capping training numbers, poor T&Cs and bad pay.
No new doctors, difficult for doctors to progress, and poor retention.
Needless to say this creates a long waiting list for patients.
The government then brings out a long-term
Lots of Love for our PA colleagues. Is this system perfect, No. Are this one group to blame? Absolutely not. Without them would more people struggle to access healthcare…
Should we spend our time slagging of our colleagues or should we be demanding Fair T&C for all.
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We see an ANP carrying out TAVIs, a doctor could only dream of receiving this level of attention during their training
🚨🚨We have seen this post from a UK hospital highlighting the first time an ANP has undertake a TAVI as first operator.
All members of the 🫀 team are valuable. However, we are concerned about the impact that this decision will have had on local trainees. 🚨🚨
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A regulator designed to uphold patient safety & public confidence in the medical profession is happy to regulate a group of individuals who are NOT doctors, & refuses to address the confusion their name causes for patients
Now they're happy to see Consultant PAs because why not?
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Times may have changed, but competition to enter medical school remains intense. Doctors have made huge sacrifices & worked hard to graduate from medical school.
It is not unreasonable for someone to expect to be addressed with their correct title, which is Doctor (Dr.).
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@doctor_dru_
Urgent escalated rate for an FY1 @ £29.00p/h in inner London, then they wonder why no one wants to take the shift
For the responsibility and risks that is not worth it
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And many doctors who undermine the profession
A main reason the PA problem is so widespread is because some doctors are willing to overlook the insidious collapse of the medical profession because PAs are nice people
It’s possible to simultaneously like PAs as people, and despise that the role contributes to the downfall
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@veggieequallife
Not to gloss over the important error this PA has made in misinterpreting the Medical Act, they are NOT a medical practitioner and claiming to be one is against the Medical Act
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Follow this thread all the way to the top, and then you wonder why doctors are concerned.
Those in senior positions at the GMC and NHSE don’t even know what’s happening with regulations of PA/AAs
It’s make it up as you go along, that’s what it’s coming down to
@deeleyc6
@wendyburn
@drdernial
@drcolinm
@NHSE_WTE
@gmcuk
They don't even know if the public wants regulation, or what version it should take. That's why it's going out for consultation... AFTER regulation is sorted in legislation.
Honestly, you can't make it up.
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Is this person a doctor or a PA/AA?
Mr Oliver Smith
GMC 6738462
Doctor
1185
PA/AA
602
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@RobertGittings
I think this is one of the biggest cons, doctors are still expected to pay a premium because everyone assumes doctors are paid well, the reality is far different.
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Trust/department to see if it’s harbouring a toxic culture that’s compromising patient safety. A priority of the GMC is to uphold patient safety
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@anticentralize
Leaving this here:
Misdiagnosis: Bereaved mum calls for physician associate role clarity
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@veggieequallife
To be blunt any postgraduate theatre time should be solely reserved for doctors, I do not see how theatre time would benefit a PA, they’re not aspiring surgeons, and going off nomenclature they are a ‘physician associate’
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@RobLaurensonD4P
I do feel for you but something tells me he never shows up to the negotiating table
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This interview raises more questions than answers, but significantly, why did
@JeanetteRCR
state that it doesn't matter who regulates PAs?
If it didn't matter, then why do doctors have their own regulator, why aren't doctors regulated by HCPC instead? 1/2
Jeannette Dickson, chair of
@AoMRC
, explaining why 'in time' PAs might be doing endoscopies and colonoscopies - "if you're properly trained and properly supervised, why not?". Also, discussion on whether GMC appropriate as regulators.
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@MarkJPearson
@gmcuk
@drcolinm
@Jcalcolado
Thank you for the clarification. I am sure that many of us will be awaiting the outcome of your investigation.
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PAs/AAs widen participations
A: Provide a liveable NHS bursary & again pay restoration
They are part of the MDT
A: They don’t provide any unique perspective and we have a good working MDT
Anything else?
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@AliJaneMoore
Public understanding is important, even this article fails to grasp that Physican Associates are not doctors. It’s a dangerous game
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Was the big orange sign lost on you?
I think it had the words Pay Restoration
The WhatsApp messages don’t reveal anything new.
A poor attempt at journalism
WhatsApp messages sent this week by the BMA to junior doctors make crystal clear what the real intentions of these strikes are.
The real reason junior doctors are striking 👇
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@quackophage
The regulator for doctors, the GMC, is addressing doctors’ concerns regarding its ability to regulate PA/AAs by accelerating the plans, and to slap any dissidents with the Good Medical Practice &
#BeKind
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Why would anyone aged 18 consider sacrificing 5 years of their life, sacrifice their social life and plunge themselves into £100,000 of debt to earn £4 extra an hour over the minimum wage?
This is before we come to the problems of relocating to another part of the UK
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Worst of all, I expect most of these rates are escalated due to the shortages during the IA. What are the rates you’re offering on non-strike days?
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@wesstreeting
@talexe
Doubling the number of medical school places doesn't solve the present-day problem or even fix the issues the NHS will face over the next decade. We need to hear policies about fixing workforce retention and postgraduate training.
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It seems you’ve failed to grasp basic economic theory
The demand for healthcare is outstripping supply.
The government is failing to keep pace with investments
Vacancies are going up because the market rate for labour isn’t enough to recruit & retain healthcare professionals
@DocAnonX
@ShaunLintern
@drmattuk
So, as I said, according to the market, your current pay is sufficient.
It could even be lower!
Vacancies are predominantly caused by an increase in posts.
Stick to the medcine (I sincerely hope you're better at that than you are English and economics!)
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No, the BMA dropped Junior from ‘Junior Doctors’
Please kindly refer to them as Doctors.
If you’re pulling out a PDF document from 2016, and then adding a 2023 date, you’re already losing the argument.
The term junior doctor is being discontinued by
@TheBMA
.
To respect this and so we can continue to distinguish between different groups of doctors, we are using the contractual term doctors in training as collectively agreed with the union.
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Remember this tomorrow when journalists begin to blame the junior doctor strikes.
This is on a non-strike day
🏥 6.5 hr wait to see a dr at Derriford Hospital in Plymouth - 156 patients waiting in the dept - definitely not the worst I have seen there.
5.5 hours wait at North Middlesex Hospital in London
6 hours at Queen Elizabeth Hospital, Woolwich
How is it going elsewhere?
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@DrEilidhMaria
There’s always a tweet and for context the GMC’s guidance on the use of physician
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The problem here is that
@mariacaulfield
hasn’t been briefed on what inflation is a measure of, and it shows.
A really good line of questioning
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NHS England: We see these completion ratios but we’d like to expand the number of Anaesthetic Associates instead
Latest competition ratios. Once again, there are many many F2+ doctors who are desperate to be anaesthetists (and would be excellent at it), who can’t get a foot in the door. This needs to change
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Blurring the line as done in this tweet is dangerous and defeats the founding purpose of the GMC.
Unfortunately, this isn’t a debate. The GMC is imposing poorly thought-out policies and guidelines to help the government fulfill its goal of dismantling the medical profession. 2/2
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If you want more doctors, and for them to be representative of the general population, they need to be paid better.
Basic economic theory ~ supply and demand of labour
You want to attract skilled labourers you have to pay the price and be competitive.
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@ERunswickBMA
How can you attack and vilify 47,000 doctors while also expecting them to be the ones to 'save your old mum in A&E'?
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If there are not enough doctors to cover wards to ensure patient safety during a normal week, how will increasing medical school places resolve this.
All of these medical students require supervision and doctors to train them.
Retention is key!
So now both Sunak and Starmer have or will pledge to “doubling” medical student numbers.
Yet neither have committed to restoring doctors’ pay/retention.
Result & translation:
UK government commits to train thousands more doctors for Australia, Canada and New Zealand 🤦🏻♂️
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@Xeon4f145d96s1
Speaks volumes about ‘accountability’ happy go around misleading people into thinking they’re a medical doctor but when they’re called out they refuse to take accountability for their actions. Unregulated, reckless and a risk to all patients
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For the government and political parties, it’s just about numbers:
How many ‘healthcare professionals’ have they recruited or trained?
How many patients have been treated or operated on?
They’ve opted for the cheapest and fastest way, expanding PAs/AAs, despite concerns
As government passed registration of PAs/AAs by the GMC today one particular clip really intrigued me:
@theresecoffey
here talks about having 1:3 supervision for AAs 🤔
We have to also remember she was health secretary - she’s seemingly marking her own homework here.
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The reasoning provided for making such a decision is absurd. Lack of resources and funding is an unacceptable justification.
2/2
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Incoming:
A two tier healthcare system
NHS (free at the point of use): ran by allied healthcare professionals and Physician Assistants
Private Healthcare: Consultant led, with doctors
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Try again, how can you justify paying a reg the same as a PA?
@Xeon4f145d96s1
Apologies, the rates on the system are not correct for these shifts. The correct rates are below:
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@ExplosiveEnema
If you don’t support the training of PA/AA you could find yourself in front of a fitness to practise panel?
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or why aren't nurses regulated by the GMC?
The regulator matters & having PAs fall under the GMC's regulatory powers opens the door to further confusion for patients & gives further opportunities to mislead the public.
Allowing for more scope creep - 'doctors on the cheap'
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@tash_binnie
It’s ludicrous, the main BBC page is covering strikes in France but nothing on
#JuniorDoctorsStrike
in the UK
@BBC_HaveYourSay
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Hello HR,
I’m owed a 20% uplift, according to Baroness Foster I should get a 20% uplift for working in London.
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This is the direction NHS healthcare is heading towards.
We will have a 'portfolio pathway' for PAs who will be admitted to a Specialist Register.
It won't be long till we'll have a debate on whether PAs can parade around calling themselves Consultant
@NHSHandSan
Prediction: “PAs who have already worked X amount of time in Y speciality have equivalent experience to the Foundation Programme therefore can go straight to core or ST level”
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@quackophage
Hello
@drcolinm
it seems a reasonable question has gone unanswered during your busy period of retweeting
@jimbethancourt
. Unfortunately that retweet isn’t going to get you into the HoL, so please respond to the doctors that are genuinely concerned about the GMC’s ability to
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@Xeon4f145d96s1
Administrative error, we apologies, a formal investigation will be conducted… no outcome and repeat
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@TomStocks1982
A doctor in training must sign off a prescription request made by a Consultant Physician Associate
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The government has the monetary resources to RESTORE doctors' pay but chooses NOT to, in order to make a political point
We've seen how much the trusts have spent covering strikes
The government can continue negotiating but chooses not to, so they can make a political point.
I DO support pay rises for training doctors
I DO NOT support the
#DoctorsStrike
The strike is a war between the BMA and Gov
Wars cause civilian casualties
No one wins a war, short or long term
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@BMA_James_Steen
@ABarotchi1
@mrthomasjacques
You would be right to do so, if this is the culture of the senior surgical team, to threaten someone with the GMC for merely raising concerns, I would hate to see what happens behind closed doors
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Vote of no confidence, Boris Johnson out and his number 2 Rishi Sunak can join him because we need NEW leadership and a NEW government!
#JohnsonOut76
#Partygate
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If you’re panicking about junior ‘baby’ doctors walking out, and going on strike for 72 hours, then clearly an FY1 is worth more than £14 an hour.
#BMADoctorsVoteYes
#PayRestoration
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In the UK, we’ve normalised paying people who are incompetent and bad decision-makers more money than highly skilled and competent individuals.
Resulting in an incompetent government led by an incompetent Prime Minister who then appoints a Health Secretary who has no clue about
Junior Doctors continue their strike today.
That means more disruption for patients and staff.
My message remains the same. Call off the strikes and come back to the table.
Let’s start 2024 right.
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One of many reasons why the GMC should not be the regulator for Physician Associates.
Those that seek to play fake doctor will use their registration with the GMC to mislead patients.
Motive always come out.
If you’re that desperate to be called ‘Doc’ - go to medical school.
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The continuous blurring of boundaries is taking us to a point where we are just experimenting an alternative approach of medicine on patients, this will needlessly be at the expense of patient safety.
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@Anniedroid_
@MedReddit
Next doctors will be expected to bring in their own laptops for ward rounds, will save the hospital thousands £
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- Removal of Educational Points, they decided in February and only told medical students in November, after many students had started their intercalated degrees.
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@JackieHammerton
@EmergMedDr
@gmcuk
@drcolinm
The point stands.
As a final year OSCE these medical students are being assessed to ensure they meet the outcomes for graduates. I am aware that medical student are continuously assessed and various forms of assessments exist.
In essence how can you justify an individual who
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Your sacrifices led to a reward, but they also enabled the government to continue creating a horrible environment for junior doctors of this generation to train in. Additionally, there are consultants who continue to pull up the ladder.
I started responding to junior doctors to encourage them that sacrifices now would be worth it long term. I’ve given up on that as all they do on here is constantly wallow in self pity. And abuse anyone who questions their views or antics.
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Isn’t it funny that
@SteveBarclay
set preconditions which included a confidentiality agreement
The very next day DHSC breeched their own preconditions & briefed the media about the meeting.
Underhanded tactics from a corrupt government
#FullPayRestoration
#JuniorDoctorsStrike
This is untrue. We set no preconditions unlike you.
These were the additional preconditions you wanted us to sign along with the others you set to get in that room.
Weird that you would blatantly misrepresent the truth like that
Who do people trust?
Politicians or Doctors?
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SURVIVAL OF THE FITTEST!
What’s the point of a fully functional society when we revert back to this theory?
#HerdImmunity
#DowningStreetBriefing
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@ParamilyUK
Findings were made against the father of domestic abuse after a finding of facts. In the final hearing a different judge pressed the mother on why she didn’t have photos of the father on her phone and showing these to the children. The system is truly broken
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Once regulations are in place, why stop at endoscopies, why don't we train PAs to do surgical procedures like open heart surgeries or total knee replacements?
Why do we need doctors who go through years of PGME, professional exams...?
Save money wherever possible
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